Metabolic Monitoring Rates of Youth Treated with Second-Generation Antipsychotics in Usual Care: Results of a Large US National Commercial Health Plan

Abstract

Objectives: To examine metabolic monitoring rates in commercially insured children and adolescents treated with a secondgeneration antipsychotic (SGA) during calendar years (CYs) 2016 and 2017. Methods: In this retrospective study, data were collected from a large national commercial health plan for the period covering January 1, 2016 to December 31, 2017. Commercially insured children and adolescents, aged 8-19 years with ‡2 SGA prescription claims during the CY, were identified for the CY2016 and CY2017 cohorts. The primary outcome of interest was the percentage of subjects with any glucose or lipid metabolism parameter monitoring. Other calculated metabolic testing rates included glucose, hemoglobin A1c (HbA1c), low-density lipoprotein cholesterol (LDL-C), other cholesterol (including triglycerides), and combined glucose and lipid metabolism testing (‡1 test for blood glucose or HbA1c and ‡1 test for LDL-C or other cholesterol). Results: In CY2016 and CY2017, 1502 and 1239 subjects, respectively, were identified for this study. The most common psychiatric diagnoses in CY2016 and CY2017 were major depressive disorder (57.1%, 56.5%, respectively), anxiety disorders (42.9%, 47.5%), attention-deficit/hyperactivity disorder (41.6%, 45.8%), and bipolar disorder (24.1%, 25.9%). The rate of any metabolic testing was 53.5% in CY2016 and 51.3% in CY2017. Glucose testing (50.3%, 46.9%, respectively) was most common in both CYs, followed by LDL-C testing (31.2%, 28.5%). Rates of combined glucose and lipid metabolism testing were 30.7% in CY2016 and 26.9% in CY2017. Conclusions: Given the known potential for adverse cardiometabolic effects, rates of metabolic monitoring associated with SGA use in children and adolescents urgently need to be improved. There is a critical need for understanding barriers to routine monitoring, particularly of lipids, and developing interventions to enhance metabolic monitoring.

Monitoring of Adverse Drug Reaction-Related Parameters in Children and Adolescents Treated With Antipsychotic Drugs in Psychiatric Outpatient Clinics

“…Although previous studies have shown differences in monitoring frequencies in children treated with antipsychotic drugs, it is clear that the monitoring frequencies were suboptimal (13,15,16,18). Overall, it has been shown that the physical parameter weight was monitored more frequently in children treated with antipsychotic drugs compared to the laboratory parameters glucose and lipids, and waist circumference was monitored much less, which is in line with the results of this current study (14,15,19).…”

“…Monitoring instructions of these parameters are available in clinical guidelines, and in regulatory drug product information such as the information leaflet (9)(10)(11)(12). Despite the existing guidelines and instructions, previous studies have shown a large variability in the monitoring frequencies of ADR-related parameters, and that the overall monitoring frequencies were suboptimal (13)(14)(15)(16). The majority of these studies used administrative databases from various settings, such as insurance companies or databases of general practitioners, but questionnaires about monitoring among prescribers have also been assessed (14,16).…”

“…Despite the existing guidelines and instructions, previous studies have shown a large variability in the monitoring frequencies of ADR-related parameters, and that the overall monitoring frequencies were suboptimal (13)(14)(15)(16). The majority of these studies used administrative databases from various settings, such as insurance companies or databases of general practitioners, but questionnaires about monitoring among prescribers have also been assessed (14,16). In-depth assessments of the medical records of children treated with antipsychotic drugs is of added value in creating a complete overview of the total antipsychotic drug therapy of the individual child and what is actually monitored and recorded in daily clinical practice, including the considerations and choices made concerning (not) monitoring for ADR-related parameters.…”

Use of Antipsychotics: The Experiences, Views, and Monitoring Practices of Child and Adolescent Psychiatrists in Turkey

“…Aripiprazole (32.2%), risperidone (30.4%), and quetiapine (14.9%) were the most commonly preferred antipsychotic drugs of the physicians involved in our study. Recent studies have indicated that risperidone, aripiprazole, and quetiapine are the three most commonly prescribed antipsychotics (Huskamp et al 2016;Hálfdánarson et al 2017;Hayden et al 2020). In a study conducted in our country, the order of antipsychotic preference in children and adolescents admitted to outpatient clinics was found as risperidone, aripiprazole, and quetiapine (Yektas x and Tufan 2018).…”

Monitoring of metabolic side-effects in children and adolescents prescribed antipsychotic medication: A systematic review

“…Fifteen papers were identified for inclusion in this review comprising four studies of self-reported clinical practice (Curtis et al, 2012;McLaren et al, 2017;Rodday et al, 2015;Walter et al, 2008) (Table 1), five data linkage studies of metabolic monitoring in children and adolescents attending mental health services (Connolly et al, 2015;Hayden et al, 2019;Morrato et al, 2010;Okumura et al, 2018;Raebel et al, 2014) (Table 2) and six retrospective chart review studies to examine metabolic monitoring (Cotes et al, 2017;Coughlin et al, 2018;Featherston et al, 2018;Javaheri and McLennan, 2019;Kauffman et al, 2018;Wakefield et al, 2019) (Table 3). Of the 11 studies which reported data from child and adolescent patients, five provided information about the diagnoses of the children (Connolly et al, 2015;Coughlin et al, 2018;Featherston et al, 2018;Hayden et al, 2019;Morrato et al, 2010). The diagnoses provided were wide ranging and representative of children attending a specialist mental health service.…”